Opening sensitive conversations about a patient’s death is never going to be easy – could more practice and candid feedback help healthcare professionals to gain confidence? James Larter, Managing Director of live learning providers RoleplayUK, explores the idea

A recent report published by the Royal College of Physicians (Talking about dying) highlighted the need for doctors to be far more proactive in engaging with patients about their death. Interestingly, it also raised the issue of confidence as being one of the three main barriers to opening conversations on quality versus longevity of life.

For doctors to get better at handling difficult conversations with dying patients, it seems clear that they need to practise and not just at medical school but at frequent intervals throughout their career to reflect the current patient relationship they encounter in their everyday roles.

Indeed, the report said: “From medical students to consultants, many of those we spoke to told us that they feel uncomfortable initiating conversations about the future with patients. Junior doctors also said that they had few opportunities to practise these conversations with feedback.”

Royal College of Physicians Oct 2018

Learn from mistakes away from the frontline

The question is, how do you prepare for a conversation about death with someone who is dying? The truth is you can’t be ready for every single scenario – healthcare professionals are not robots and cannot learn a response to thousands of potential situations. Besides, being “in the moment” and responding to a patient’s emotions as they unfurl before you is an incredibly important and delicate skill to have.

The challenge is bringing up the topic in the first place and relaying medical information to a patient in a sensitive and understanding way. And this can be practised, in a safe consequence-free environment; helping individuals to gain confidence and become better at having difficult conversations.

This is where skills coaches who are also professional actors can come in. As professional actors they can realistically assume the role of the patient, building in appropriate specifics to their character and scenario to reflect exactly what each individual healthcare professional needs to practise.

Not only that, they can provide invaluable insight into the impact of the individual’s choice of language, tone and approach in general. Their feedback, in character, is a unique opportunity to experience what it’s like to be on the other end of your own conversation, to see yourself as others see you. A reality check on whether that rapport you think you’re building, as how others perceive you.

In just an hour’s session individuals can try out conversations, really learn from their mistakes, and grow in confidence as they re-run elements that might not have quite gone to plan. Offering a win-win for both patients and doctors.

In person or remote

We have found that remote practice realplay sessions, by video link, are equally as effective as face to face in person but with the added benefit of being more accessible to busy staff.

We understand that medical professionals can struggle talking about death with their patients. It’s not something any of us really prepare for and even though GPs and junior doctors have more training than most of us, circumstances change and it’s important that these vital communication skills are refreshed and kept up to date.

If doctors have the opportunity to practise this type of conversation, in a safe, consequence-free environment, and importantly receive immediate feedback on the impact of their approach, we could shelter a lot more individuals from distress – and make it easier for doctors too.

There are many skills coaches who are involved in programmes which address training just like this, enabling individuals to try out sensitive conversations and learn from their mistakes. The results speak for themselves, nurturing the confidence to manage conversations professionally and with empathy.

Personally, I found the report ‘Talking about dying: How to begin honest conversations about what lies ahead’ from the Royal College of Physicians extremely insightful into how doctors and healthcare professionals could be better supported to talk about dying, within a culture where death is often perceived as a failure. They summarise their findings with:

“During our research, we identified that the timely, honest conversations about their future that patients want are not happening. Many physicians do not feel confident to initiate these conversations, to handle prognostic uncertainty or to discuss decisions about care and treatment that balance duration and quality of life.

Currently, attitudes within the profession and culture of targets and pressure within our healthcare system do not support physicians to easily prioritise proactive conversations in a clinic or on the ward.

Yet, these discussions are fundamental to effective clinical management plans, part of being a medical professional and align with the aspirations of the RCP’s Future Hospital Commission Report. Given the increasing proportion of people living with one or more long-term condition, it is more important than ever that we do not shy away from these conversations. This is a challenging problem: it requires doctors, medical systems and societal attitudes to change.”

I for one, feel there’s a great deal that the L & D sector can do to develop and maintain this important skillset. Doctors should be supported to feel confident to raise the right conversations, at the right time and share their medical knowledge compassionately.

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